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General NPI Number Information
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NPI Number | 1841834967
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Entity Type | Individual
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Provider Name | LAURENCE VALERIE AGENOR PT, DPT, CSCS
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Gender | Female
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 485 MADISON AVE FL 8
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City | NEW YORK
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State | NY
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Zip | 10022-5803
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Country | US
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Telephone | 212-980-2963
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Fax |
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Provider Business Mailing Address
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Address Line | 117 E 37TH ST APT 5D
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City | NEW YORK
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State | NY
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Zip | 10016-3048
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Country | US
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Telephone | 301-580-5150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 044135-01
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License Number State | NY
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